T2 - am I correct these are my two options?

Adm_Mad

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I was diagnosed T2 in April, and my GP gave me three months to try and manage with diet and exercise alone. So, so far I am not on medication or insulin.

My starting HBA1C was 9.3 and the confirmation fasting finger prick test my GP did was 12 point something. I immediately cut carbs and started to lose weight as fast as I could, and by the start of May had got my predicted HBA1C (via the MySugr app which it stresses is just an estimate based on your daily readings) down to 5.1, taking between 4-8 finger prick tests a day averaging 4's and 5s, with a few 3's.

HOWEVER... that was just the first few weeks. In the last few weeks, i.e. most of May, my fasting readings have been creeping up into the 6's and 7's, with some others spiking into 8's and some post-prandials also spiking into 8's. I have NOT changed anything, haven't gotten slack and started eating more carbs, eating more calories, or exercising less. My predicted HBA1C has now risen to 5.2% and I'm guessing 5.3% isn't far off.

(Side note: is it possible to not have eaten enough but your blood sugar not be low enough to hypo? Because my weekly calorie deficit is in the thousands, and I'm hungry and tired all the time, but my blood glucose levels have never dipped low enough to hypo.)

The only times I've been able to get my fasting blood glucose back down into a 5 is when I eat nothing for at least 36 hours. The best I achieved was yesterday morning when I got a 4.5 in the morning, after having not eaten for 54 hours. I managed to stay not eating for some of the day but kept getting dizzy spells and seeing spots in front of my eyes, and I caved and ate an avocado, a 10 g cube of Parmesan and a hard boiled egg at 4 p.m. and my pre and post-prandial readings shot from 4.4 to 7.0, I ate nothing else for the rest of the day, and my reading this morning was 7.2.

Edit to clarify: this spike from 4.4 to 7.0 has been the only time this month that the spike itself has been so big. The rest of the time my post-prandial levels have been in the high 7's and 8's only because my pre-prandial has been higher, because my fasting level seems to have inexorably risen.

Am I correct that with these kind of readings it's likely that I am simply not able to manage to control my diabetes with diet alone, and that I will have to start medication? Because I have to be totally honest and say that feels like the beginning of the end, as decline into disability and early death (however many years it takes) seems to start with requiring medication.

I have been steadily losing weight due to my calorie deficit, and am close to my first goal weight of 64 kg, starting from 73.

So am I correct that these are my two options:

1. Go on medication and eat closer to the number of calories I should be getting.

2. Try to manage with diet alone but be eating way less than I should be.

I am still very stressed and depressed about my diagnosis, which I know probably isn't helping my levels. I know there isn't really a solution to depression apart from trying to not be depressed.
 
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JoKalsbeek

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I think your diet may need re-thinking.... I have no calorie deficit, just eat keto (20 grams of carbs or less per day), and I lost 25 kilo's that way. You still need energy, and if it's not coming from carbs, it has to come from somewhere. You're basically starving yourself, and who knows, your liver may be dumping glucose to compensate, but that's just a guess. Besides, with the spots and dizzyness, you could well be deficient in salt as well, and getting low bloodpressure. I'd make an appointment with your doc to get a c-peptide and GAD test, bloodpressure and whatnot, just in case there's more going on. Because this isn't sustainable. Others here with more knowledge will chime in, I'm sure. But I think you really should, for the moment at least, not be deficit in calories. See how that goes. Just count carbs, that'll be enough.
 

Adm_Mad

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@JoKalsbeek Except counting carbs isn't enough as my levels have started rising. I've accepted I can't do anything about dawn ****** phenomenon as that seems to be one of the (many) things about this disease beyond control. But eating causes a spike, this seems agreed on, so it makes sense to eat as infrequently as you can. And the fact that the only time I've been able to keep my blood glucose in the 5's this month has been when I didn't eat for over two days seems to confirm this.

I know I'm starving myself, as in technically getting far fewer calories than I probably should be. But (1) I'm not really starving as I'm still overweight and have weight to lose and (2) it's seems to be a necessary evil at this point.

Based on the current situation I am being as tough on myself as I can and it looks like I can eat and have higher levels, or not eat and keep them lower, I can't have both. I'm asking if other people agree this looks like the choice I have to make. :)

Post edited for language.
 
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Goonergal

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Based on the current situation I am being as tough on myself as I can and it looks like I can eat and have higher levels, or not eat and keep them lower, I can't have both. I'm asking if other people agree this looks like the choice I have to make. :)

I don’t think it’s as simple as that. If you’re eating very few carbs then your levels should be low. One of the joys of keto/lchf is not counting calories. I’d agree with @JoKalsbeek get a doctor to check you out, including the c-peptide and GAD tests.
 

JoKalsbeek

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@JoKalsbeek Except counting carbs isn't enough as my levels have started rising. I've accepted I can't do anything about dawn bloody phenomenon as that seems to be one of the (many) things about this disease beyond control. But eating causes a spike, this seems agreed on, so it makes sense to eat as infrequently as you can. And the fact that the only time I've been able to keep my blood glucose in the 5's this month has been when I didn't eat for over two days seems to confirm this.

I know I'm starving myself, as in technically getting far fewer calories than I probably should be. But (1) I'm not really starving as I'm still overweight and have weight to lose and (2) it's seems to be a necessary evil at this point.

Based on the current situation I am being as tough on myself as I can and it looks like I can eat and have higher levels, or not eat and keep them lower, I can't have both. I'm asking if other people agree this looks like the choice I have to make. :)
The higher levels are why I suggested C-peptide and GAD tests. Could be your liver overcompensating. Could be there's something else going on, like late onset type 1, which those tests would either confirm or deny. And that won't be helped with diet or pills alone. It's a bit weird, unless someone corrects me on that, and you need to know why it's happening. If there's a question about what type you are, there's no answer to your either-or scenario's. In the meantime I do think maybe adding a little extra salt to your diet may keep the dizziness at bay.

Sorry I don't have a proper answer for you. Just too many unknowns and variables here. :(
 
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Adm_Mad

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@Goonergal I have my next appointment with my GP tomorrow night (mainly because she's wanting to track my mental health which I admit is absolutely terrible currently).

Respectfully and politely, as I know this is a very unpopular view on this forum, I wouldn't say that calories don't matter at all on LCHF. If you need to lose weight, you need to be at a deficit. It's just that for some people - not all, but some - eating fat satiates hunger which makes eating at a deficit easier.
 
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Tophat1900

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Just a few thoughts to ponder. Lots of reasons why your numbers could be hitting 8's post prandial and be somewhat raised. Could be a food item you are not aware of spiking levels, poor sleep, stress, over counter medications can, colds etc.

Some times physiological insulin resistance (PIR) will raise FBG levels. And that's ok.

And honestly, the difference between a Hba1c of 5.1 and 5.3 is trivial in the long run.

Starving yourself to the point of being dizzy isn't healthy and clearly isn't a solution. That is pushing things to the point where the liver is having to potentially add glucose to the system due to the lack of food to fuel your system. This raises the BG level. It's also creating a need to break down muscle mass to get the protein needed to keep vital organs functioning right.

Fasting does work, but if you are pushing it way past the point of practical at the expense of food because you think you need to see FBG levels at 5 each morning, then that is just not creating a stable platform that can be sustained. You're only a few weeks into low carb, you can expect things to be a bit mixed as you learn from one day to the next. If you have a lot of insulin resistance then you have to give it time to adjust to a new way of eating that the body isn't used to. We don't all respond in a uniform way to keto or LC and it takes time to figure out what works best in terms of food and foods. Sometimes too much protein can be problematic for example. I hope things work out for you.
 

Tophat1900

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@Goonergal I have my next appointment with my GP tomorrow night (mainly because she's wanting to track my mental health which I admit is absolutely terrible currently).

That could well be a prime suspect for your levels rising or part of the reason.

Good luck with your appointment.
 

Adm_Mad

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@Tophat1900 Yep like I say, I'm aware stress can be a trigger for elevated levels. But to be totally honest I've been suicidally depressed ever since my diagnosis in April and that hasn't changed yet despite having been prescribed antidepressants etc. So my slight rise in fasting BGL this month can't be exclusively down to my mental health. Thanks for the well wishes. :)
 
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Goonergal

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respectfully and politely, as I know this is a very unpopular view on this forum, I wouldn't say that calories don't matter at all on LCHF. If you need to lose weight, you need to be at a deficit. It's just that for some people - not all, but some - eating fat satiates hunger which makes eating at a deficit easier.

I don’t think that calories don’t matter at all - for sure, over eating causes weight gain - just that they’re not the best thing to focus on as it’s too easy to get stuck in the ‘calories in, calories out’ mode of thinking which in my opinion isn’t helpful. Over eating can just as easily mean eating too frequently as too much - the key is finding the balance between meal frequency and carbs: if you eat in a time restricted window, keep carbs to a minimum and eat to satiety then as a type 2 your levels should come down - that’s a much more important driver than weight loss as you’ll be dealing with the underlying insulin resistance, which in turn will help with weight loss.

Hope your GP is able to help you find a solution.
 
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Adm_Mad

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@Goonergal Like I say, I know that thinking calories aren't totally irrelevant to absolutely everybody is not a popular opinion on this forum, so I'm happy to agree to disagree. :)
 

Goonergal

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@Goonergal Like I say, I know that thinking calories aren't totally irrelevant to absolutely everybody is not a popular opinion on this forum, so I'm happy to agree to disagree. :)

Hi @Adm_Mad

Really don't want to turn this into an unhelpful discussion, but wanted to clarify (for others that may be reading as well as you) that I wasn't totally disagreeing with you as I don't think calories are totally irrelevant.

Rather, I was trying to make the point that there is no need to starve yourself to achieve better blood glucose levels (and the calories in, calories out view can lead to that); rather being mindful of what, when and how often you eat would be a better strategy from a blood glucose management/insulin resistance point of view.

I'll shut up now!
 

Daibell

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Hi. As others have said, do ask your GP for c-peptide and GAD tests to check whether you are in fact T1. Forget calories as they are not useful as a food intake measure due to the body handling different foods in different ways. You need to keep the carbs down and have enough fat and proteins to keep you feeling full. Without any test results you may need some medication anyway. The test results may then help the GP decide the best medication.
 

Guzzler

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I would just like to add that it took the best part of a year for me to get a decent fasting level. I honestly think you are pushing yourself too hard at this point.

As for your GP allowing you three months to try a dietary approach, remember that all treatments etc are ultimately your decision. It would be wise to prioritise your mental well being at this point imo.
 
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Adm_Mad

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I’ve just seen from a post edit by a moderator that ****** rhymes with muddy counts as a profanity here. My apologies, I won’t do it again. If anyone has a problem with my language it’s ok to contact me directly to ask me to tone it down.

I get for some people calories don’t matter but I need to lose weight and for me they do. If you have a physiognomy/metabolism where calories are totally immaterial to whether you lose weight or not that’s terrific for you and I’m very jealous but I don’t.

Edited by mod to remove poorly disguised profanity, however apology accepted.
 
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This isn’t especially unusual. I believe the mechanism is that falling insulin levels allow more “whole body” glucose to spill into the blood. One has to remember that it takes decades for the body to fill with sugar, and you can’t empty it in five minutes. It’s early days. Play the long game and things should eventually settle down.
 
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kitedoc

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Hi @Adm_Mad, at some point you will need to stop a calorie/energy deficit diet.
Particularly if you are getting symptoms suggesting possible harm.
And what has happened to each of the contestants on the Biggest Loser programs.?
They end up regaining weight, or they have to keep calorie-deficit diets forever and keep up humungous amounts of exercise ( well at least til their joints wear out.).
Also they are monitored during weight loss by nutrition experts who may alter their vitamins and minerals intake according to what is thought to maintain best health.
You don't have that back up and i would hate to see you rebound.
When you compare you bsls against the acceptable ranges you appear to be doing splendidly. If you worry about every 7 mmom/l and every kg that will only make you more stressed.
As others have said, changing over to fat burning or keto is another option and it has been shown to work and be more sustainable long term than the calorie deficit model.
Fat has more calories than protein and carbs so as you burn it and prevent your muscles wasting from not enough calories from protein you may find life a lot more satisfying and for me as a type 1 with mental health troubles i have been far better and lost some weight as well on a keto diet.
Eating fat in order to burn allows you to absorb the protein, minerals and vitamins your body needs. By lowering carbs below 30 g ( what is recommended - see dietdoctor.com)
your body burns the fat, it does not add to your body weight, just a petrol in the fuel tank once burning does to cause one's car to accumulate weight. But if the car is fed another fuel source, or made to try to evaporate the fat fuel this puts strain on the car, weakening the its structure over time and the result is far worse.
Diet.doctor.com can show how the initial experience of going keto are like and how to deal with the change over and the temporary ' keto flu'.
Once into the 'groove' of it you may be surprised how much better you feel whilst still losing weight.
And dawn phenomenon may reduce or disappear as the stress of calorie-deficit dieting ceases.
Please give it careful thought for your overall health's sake.
Spoken by another Aussie to you!! Best Wishes.
 
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Caeseji

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I’ve just seen from a post edit by a moderator that b****y rhymes with muddy counts as a profanity here. My apologies, I won’t do it again. If anyone has a problem with my language it’s ok to contact me directly to ask me to tone it down.

I get for some people calories don’t matter but I need to lose weight and for me they do. If you have a physiognomy/metabolism where calories are totally immaterial to whether you lose weight or not that’s terrific for you and I’m very jealous but I don’t.

I'll agree that calories do matter in a sense but in the eyes of our basal metabolic rate, if you eat so little that you are starving yourself then you're going to lower that number down more and more till you have to starve MORE just to get over it. I've found that cycling my caloric intake a bit to keep my body on its toes has gotten me into the 16 stone category now. I still practice fasting just I have a 16:8 schedule of NOT watching calories for a few days then like today I either do a full on 36 hour fast or one meal at a 24 hour fast to restrict intake and have a decent meal once I break it.

I understand the strains really I do, wanting to get better and wanting to be at the same level as others but honestly pushing for lower numbers is a bit of a new thing with T2 at least relatively new. If you're hungry and tired all the time then your body is trying to tell you something, that added to the stress of how you're handling all this could be what is driving your numbers up along with a healthy dose of physiological insulin resistance as your muscles have gone into fat burning/glucose sparing mode so your brain doesn't pack in with the lack of energy.

Try some alternate day fasting? Or something like the 5:2 diet for a month and see how it goes? Sometimes it takes a while to take but I did find that having a proper schedule to my eating has lowered my anxiety a lot about my situation too. I know it's a tired adage but it is a marathon and not a race, that goes for weight too. Once you've depleted the visceral fat considerably then you'll start to see lower numbers consistently. It's only really now a few months in that I am starting to understand my condition as being unique in its ways like my postprandials even with some carbs thrown on willy nilly without counting and protein to boot are giving me just baseline numbers without a spike.

You'll get there, I know it sounds a bit hollow when you're in a dark place but you will get there eventually. Keep in touch with your team and make sure you're getting everything you need. Don't punish yourself for the weight or the diabetes, life has done enough of that to you for you to be doing it to yourself as well.
 

Resurgam

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I am puzzled that you don't see your blood glucose levels as a positive as it is so soon after diagnosis.
I concentrated on the carbs - and still do for that matter, would never consider starving to the point of feeling faint - it has never worked in the past so no point - but once I had a meter I saw that the averages were dropping week by week. There was a period of very erratic readings after a few months but that passed and then they went on down.
Do give yourself some time so your metabolism can recover its equilibrium and start to sort out all the various systems involved. You seem to be punishing your body rather than nurturing it, and I can feel how much stronger I have become, and seen normal Hba1c tests, so I really would advise that you allow time for recovery as to see 7s and 8s in the first month after diagnosis is success, not failure.
 
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bulkbiker

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Am I correct that with these kind of readings it's likely that I am simply not able to manage to control my diabetes with diet alone, and that I will have to start medication? Because I have to be totally honest and say that feels like the beginning of the end, as decline into disability and early death (however many years it takes) seems to start with requiring medication.
No not in the slightest..
When I was first diagnosed by FBG's were in the 7's and 8's for the first 3-4 months. You have been following low carb for less than 2 months and have had FBG"s in the 4's and 5's which is absolutely amazing.
Starving yourself however will not help with blood sugar or weight loss.
Not sure how much weight you have to lose but you need to build a sustainable regime that you can follow for months.
Your slightly higher FBG's could well be down to the body releasing the stored sugar and burning it off so should be applauded not dreaded.
Intermittent fasting and ultra low carb was my chosen path but it took months to get anywhere near the levels of FBG you have already achieved.